DESCRIPTION (adapted from the application) Neil R. Powe, M.D., is Associate Professor of Medicine and Director of the Welch Center at the Johns Hopkins University School of Medicine. He holds a joint appointment in the Department of Epidemiology at the Johns Hopkins School of Hygiene and Public Health where he is Director of the Clinical Epidemiology Program. He is seeking this Midcareer Award in Patient-Oriented Research to concentrate his effort in clinical research in kidney disease and build the training program in kidney disease research. Dr. Powe has conducted several clinical investigations in nephrology over the past 12 years including a study of the effectiveness of recombinant human erythropoietin for treatment of anemia of ESRD (end stage renal disease), a study of the incidence, risk factors and prognosis of septicemia in ESRD patients, a study of co-morbid cardiovascular disease in ESRD patients, a study of the natural history and risk factors for ESRD among patients with diabetes mellitus, a study of the impact of dialysis care deficiencies on patient mortality and hospitalization, a study comparing physical examination with color flow Doppler for detection of vascular access failure and a randomized clinical trial and observational studies of high versus low osmolality contrast media-induced nephrotoxicity. Dr. Powe directs the Choices for Healthy Outcomes in Caring for ESRD (CHOICE) study. This is a national prospective cohort study comparing peritoneal dialysis and hemodialysis and a large versus small dose of dialysis. The study now has over 1034 patients enrolled making it one of the largest and most representative prospective cohorts of dialysis patients ever studied in the U.S. Data on medical history, laboratory studies, co-morbidity and severity of disease and clinical outcomes are being collected. The study has also established a specimen bank which provides exciting opportunities for studies examining both the etiology and consequences of kidney disease or its treatment. Dr. Powe has mentored a cadre of trainees and junior faculty in clinical research in kidney disease. This award will permit Dr. Powe to make even a greater contribution to patient-oriented research in nephrology, concentrating his efforts and helping him produce future clinical scientists who are rigorously prepared to becomes independent investigators in kidney disease research.